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BACKGROUND. A considerable body of evidence supports the concept that a significant number of cutaneous malignant melanomas progress through a precursor lesion or dysplastic melanocytic nevi (DN). Tumor angiogenesis likely plays a critical role in early development of melanoma, and intermediate biomarkers of angiogenesis could be useful as chemoprevention and prognostic markers. METHODS. Markers of angiogenesis that included expression of the vascular endothelial growth factor A (VEGF-A) and microvessel density counts (MVD) were evaluated in 13 prospectively collected benign nevi (BN) and 19 DN from 16 individuals and in a comparison group of 17 primary melanomas (16 archival samples and 1 prospective melanoma). RESULTS. VEGF expression in melanocytic cells (mean ± standard error [SE]) was low or absent in BN (3.4 ± 1.4), increased significantly in DN (41.0 ± 10.1; P = .0003 for BN vs DN), and increased further in primary melanoma (119.9 ± 28.3; P = .06 for DN vs melanoma). MVD using CD31 (mean ± SE [percentage × intensity]) followed a similar pattern with similarity between BN (2.6 ± 0.7; N = 13) and DN (2.2 ± 0.8; N = 19; P = .4 for BN vs DN), whereas primary melanomas were significantly higher (39.4 ± 6.4; N = 17; P = .0001 for BN or DN vs melanoma). CONCLUSIONS. In a prospective setting, the current data suggested that increased VEGF-A expression in DN may be a good indicator of preneoplastic change in melanocytic lesions with the potential for improving the understanding and prevention of the transformation of DN to melanoma. Cancer 2007. © 2007 American Cancer Society.

A newborn male presents with a plaquelike lesion over the left iliac crest. ### Prenatal History ### Birth History ### Hospital Course At birth, an otherwise healthy newborn Hispanic male had a 12.0 x 9.0 x 1.0 cm gray plaque, characterized by small, flat clusters of pink vascular papules, over his left iliac crest. Results of a complete physical examination were within normal limits, including no pertinent cardiac or neurologic findings. Which studies would you obtain for further evaluation of this patient? Laboratory evaluation results included a normal complete blood count without thrombocytopenia or anemia and a normal disseminated intravascular coagulation panel without hypofibrinogenemia, elevated D-dimer, or prolonged coagulation studies. A wedge biopsy of the plaque was performed under general anesthesia at 3 weeks of age. Immunoperoxidase studies were obtained on …

Kaposiform hemangioendothelioma was initially described in 1979 and is a rare pediatric vascular tumor that may be associated with Kasabach-Merrit phenomenon. We present a newborn boy who had a large vascular lesion over his left iliac crest without evidence of retroperitoneal involvement or inguinal lymphadenopathy. We briefly review the neoplasm's unique characteristics, histopathology, prognosis, and treatments.

A 16-year-old healthy white male adolescent presented with an asymptomatic swelling behind his ear. The lump was superimposed on what was thought to be a congenital nevus that had been present since birth. His family history and medical history were noncontributory. Physicalexaminationrevealeda largebrown-blackhyperpigmented plaque involving the posterior aspect of the neck and extending up to the mastoid and occipital region of the scalp (Figure 1). The plaque was of varying thickness, being macular on the inferior portion and spongy and infiltrative near the superior and mastoid portions. This variation in thickness was a continuous, gradual change. The lesion also demonstrated some variation in pigment and moderate hypertrichosis. A diffuse spongy nodule behind the ear was more palpable than the rest of the plaque (but not visible on the photograph). No other lesions were found. Two punch biopsy specimens were obtained: one from the thick, spongy area behind the ear and the other from the proximal area of the occipital region of the scalp, which was macular and thin and resembled the majority of the plaque (Figure 2 and Figure 3). Neither specimen was obtained from an area that was particularly dark. What is your diagnosis?

Cyclooxygenase 2 (COX-2) is an inducible enzyme involved in the production of prostaglandins and thromboxanes during inflammation. There are now several lines of evidence indicating that increased expression of COX-2 plays a functional role in the development and progression of malignant epithelial cancers. However, there is only limited data regarding the role of COX-2 in melanoma pathogenesis. In the present work, we retrospectively examined lesions through out the development of melanoma and metastatic disease (dysplastic nevi n = 10, melanoma in situ n = 4, stage II melanoma n = 10, stage III n = 4, stage IV n = 3, stage V n = 2, melanoma metastasis lymph nodes n = 13 metastasis to other sites n = 3). COX-2 was consistently observed in keratinocytes, dermal fibroblasts, and inflammatory cells in regions adjacent to benign evi and primary cutaneous melanomas. However, no COX-2 staining was detected in the nevi nor in the primary skin melanoma cells. In addition, COX-2 was undetected in all vertical and radial growth phase cases Interestingly, 13 out of 13 of the lymph node metastasis expressed extremely high levels of COX-2 in overlying epithelium and inflammatory cells, and COX-2 was strongly detected in the metastatic cancer cells per se. For additional information on the expression of COX-2 in malignant melanoma, we determined the expression of COX-2 protein in several different melanoma cell lines. We found that 3We found that 5 out of 7 of the melanoma cells over expressed COX-2 compared to normal melanocytes. Collectively, these data suggest that COX-2 may play a functional role in metastases of melanoma, and treatment with COX-2 inhibitors may be efficacious for malignant melanoma.

Pigmented vulvar lesions were observed In a child during a sexual abuse evaluation. Gross examination of the lesions appeared most consistent with bowenoid papulosis; however, biopsy confirmed the le-sions to be pigmented apocrine hamartomas. To our knowledge, these rare and benign tumors have never been described as pigmented, but should be added to the differential diagnosis of pigmented vulvar lesions.

REPORT OF A CASE A 67-year-old white man with metastatic melanoma began therapy with continuous intravenous suramin infusion. On the third day of treatment, an asymptomatic eruption developed over his upper trunk and arms. Numerous nonconfluent 2- to 3-mm papules, pustules, and vesicles on an erythematous base were present (Fig 1). They were randomly distributed. The patient otherwise felt well, and the findings from his physical examination were normal, except for the cutaneous changes. A punch biopsy specimen of one of the papules is shown in Figs 2 through 4. What is your diagnosis? DIAGNOSIS: Squamous syringometaplasia (squamous metaplasia) of the eccrine glands. HISTOPATHOLOGIC FINDINGS An acanthotic squamous epithelium with overlying parakeratosis was seen. Moderate dysplastic features were present in the epidermal keratinocytes and the acrosyringium. A mild chronic inflammatory infiltrate was seen in the upper dermis. The dermal eccrine coil and glands were uninvolved

Seven cases of syringocystadenoma papilliferum were studied by immunohistochemical methods for the presence of IgG, IgA, IgM, and secretory component in tumor epithelial cells and IgG, IgA, and IgM in plasma cells underlying the tumor epithelium. Six of seven cases showed IgA positivity within epithelial cells, one case showed faint intraepithelial IgG staining, and none stained for IgM. Four of five cases were positive for secretory component. The plasma cells were predominantly of the IgG and IgA class. These findings suggest that the association of plasma cells with this tumor is a consequence of epithelial attraction via a mechanism similar to that utilized by glands of the normal secretory immune system.

We have studied 28 patients with well-documented herpes gestationis (HG) to determine the frequency of complications and to review the histopathology, immunopathology, and clinical parameters of disease. The frequency of miscarriages and other maternal complications in our series was not extraordinary. Fetal complications were similarly limited. Less than 5% of infants had cutaneous lesions, and no other untoward fetal complications were apparent. Although the clinical features of our patients largely paralleled those typically reported for patients with HG, several variants of disease were noted. We report one woman with immunofluorescence-confirmed HG who had no clinical disease during a subsequent pregnancy. We also identified cases in which the characteristic vesiculobullous lesions of HG never developed. Instead, four women had urticarial papules or plaques throughout their clinical courses. HG was verified in these four women by typical immunofluorescent findings and by recurrent, classical disease during subsequent pregnancies in two. In addition, two women were identified with recurrent HG during pregnancies by different husbands.

Human graft-versus-host disease (GVHD) has several cutaneous manifestations, including a lichenoid and a sclerotic injury pattern. A versatile animal model of graft-versus-host skin disease (GVHSD) would facilitate study of the pathophysiology of these two cutaneous injury patterns. We have examined two murine chimeras histologically and have found two distinct patterns. Allogeneically transplanted B1/6 mice show a prolonged lichenoid-interface dermatitis that eventuates in clinical alopecia, whereas LP/J recipients of allogeneic cells do not show hair loss. Their histopathology consists of an early lichenoid phase that abates and is replaced by dermal sclerosis. Because of the versatility of the mouse as a laboratory animal, we feel that this model provides an excellent opportunity to define the immunopathologic mechanisms responsible for skin injury in GVHD. In addition, an understanding of the pathogenesis of the T cell-dependent, lichenoid, and sclerotic patterns of tissue injury in GVHSD might well provide insight into the pathogenesis of the GVHSD analogs, cutaneous lupus erythematosus and scleroderma.

• A 36-year-old man who had Crohn's disease of the distal part of the colon developed widespread cutaneous lesions that, on histologic examination, showed the same type of granuloma formation found in the affected bowel. Other skin manifestations of Crohn's disease are reviewed. ( Arch Dermatol 1982;118:1006-1009)

• Subacute cutaneous lupus erythematosus (SCLE) is a recently described distinct subset of lupus erythematosus (LE) having characteristic clinical, serologic, and genetic findings. This study describes the histopathologic characteristics of SCLE and determines whether it could be differentiated from discoid lupus erythematosus (DLE) on histopathologic grounds alone. Biopsy specimens from 33 patients having either SCLE or DLE, as defined by strict clinical criteria, were examined without knowledge of the clinical diagnosis. Histologic discrimination between SCLE and DLE was accomplished in 82%. The specimens from DLE lesions had substantially more hyperkeratosis, basement membrane thickening, follicular plugging, and superficial and deep inflammatory cell infiltrate, while SCLE had more epidermal atrophy. The histopathologic differences between SCLE and DLE further support the concept that SCLE is distinct from DLE and should be considered a unique subset of LE. ( Arch Dermatol 1984;120:332-337)